Introduction Robotic surgery is a safe approach for gastric cancer. Most available evidence originates from East Asia, while data from European centers remain limited. This study aims to compare surgical and oncological outcomes between different countries, focusing on the number of lymph node retrieved. Materials and Methods We included adult patients who underwent curative-intent distal or total robotic gastrectomy for gastric cancer between 2017 and 2024 at specialized centers in Tuscany (Italy) and the Seoul National University Hospital (South Korea). Results A total of 700 patients were enrolled, including 232 Italian and 468 Korean patients. Western patients were older, had a higher comorbidity burden, and had more advanced disease (64.7% vs. 28.6%). Neoadjuvant chemotherapy and D2 lymphadenectomy were more frequently performed in Western centers, whereas D1+ was preferred in Eastern centers (p<0.001). Median node retrieved was 34 (West 38 vs. East 33 nodes), exceeding oncological thresholds (>15) across all pathological stages. Lymph node retrieved increased with pT stage and was independent of age, while higher BMI was associated with lower nodal retrieval (31 vs. 35 nodes). Postoperative surgical complications were higher in the Western cohort (13.4% vs. 8.1%, p=0.029), with an increased rate of anastomotic leakage (p<0.001). Length of stay and perioperative mortality were comparable between centers. Conclusion Robotic gastrectomy ensures adequate lymphadenectomy and acceptable perioperative outcomes in both Italian and Korean centers. Observed differences in operative efficiency, morbidity, and survival mainly reflect variations in patient selection and disease stage rather than surgical quality, supporting centralization and earlier diagnosis at Western populations.

Background Textbook Outcome defines the ideal perioperative course after surgery. A specific Textbook Outcome in Gastric Surgery (TOGS) was developed in Western centers; however, its validation among Eastern patients has rarely been investigated. We assessed its achievement in a Korean cohort and identified its predictors. Methods We included adults who underwent curative distal or total gastrectomy for gastric cancer (GC) between 2013 and 2023. TOGS consisted of three surgical criteria (no intraoperative complications, R0 resection, and adequate lymphadenectomy: > 20 nodes in subtotal and > 25 in total gastrectomy) and four postoperative criteria (no re-intervention, no unplanned intensive care unit stay, no unplanned 90-day readmission or mortality). Results Of the 5806 patients with GC enrolled, 4338 (74.7%) achieved the TOGS, with rates of 77.9% for stage I tumors and 68.8% for stages II-III. The TOGS rate declined with age, from 82.3% in patients aged < 40 years to 67.5% in those aged >80 years, with hospital readmission being the strongest negative predictor of its achievement in the elderly. Several factors were independently associated with a higher likelihood of TOGS: early lesions (P = 0.003), female sex (P < 0.001), recent surgery (P = 0.024), distal gastrectomy (P < 0.001), and minimally invasive approach (P < 0.001). Patients with TOGS had shorter hospital stays (P = 0.014) and improved 5-year overall survival (87.6%, vs. 75.6%, P < 0.001), independent of the pathological stage (stage I, P < 0.001; stages II-III, P < 0.001). Conclusions The new definition of TOGS provides valuable insights into the quality of surgical care for patients with GC and has a strong impact on oncological outcomes, including in Eastern patients.

Surgical training programs primarily emphasize technical skills for diagnosis and treatment. However, communication and interpersonal skills are equally essential for residents. Trainees often face sensitive situations, such as delivering bad news and discussing end-of-life decisions and lack of communications skills could result in a negative impact on patients and malpractice claims. Despite their importance, communication skills training is often underrepresented in surgical education. This study aimed to explore the extent to which such training is offered during surgical residency in Italy, and to investigate how surgical trainees and young surgeons perceive their own communication competence and confidence, particularly in emotionally demanding scenarios. The “COSTRUIRE” (COmmunication Skills TRaining in sUrgIcal REsidency) survey, conducted from July to September 2024 by the Young Group of the Italian Society of Surgical Oncology, utilized a 30-item online questionnaire to gather data on participants’ communication experiences, emotional experiences, burnout risk, and training preferences. The responses were analyzed in accordance with the CHERRIES guidelines. A total of 189 participants met the inclusion criteria, including general surgery residents (61.4

Textbook Outcome (TO) combines optimal surgical outcomes into a single measure. This study evaluates achievement of TO using a multicenter database, assessing hospital variation, its correlation with early and late results, and refining a tailored definition of Textbook Outcome in Gastric Surgery (TOGS). Data from patients undergoing curative gastrectomy (2011–2020) in Italian centers affiliated to the Italian Gastric Cancer Research Group (GIRCG) were analyzed. TOGS was introduced at the 2024 GIRCG Annual Meeting in Siena (Italy). Among 1988 patients (median age 72 years, BMI 24.9 kg/m2), 1523 underwent surgery in higher-volume centers (≥ 30 cases per year) and 465 in lower-volume centers (15–30 cases per year). TO was achieved in 54.6

BACKGROUND Neoadjuvant chemotherapy is the standard of care for locally advanced gastric cancer (GC) in the Western countries. However, limited data are available on the timing and patterns of recurrence in this setting. AIM To evaluate recurrence patterns and timing of neoadjuvant/perioperative chemotherapy in patients with GC, analyze factors influencing recurrence, update relapse-free survival (RFS) and overall survival (OS) estimates. METHODS A total of 91 patients with resectable GC were enrolled between September 2010 and August 2016. Participants were then randomized in a 1:1 ratio to receive either 4 cycles of neoadjuvant chemotherapy (arm A) or a preoperative plus postoperative consisting of 2 cycles of docetaxel, oxaliplatin, and capecitabine chemotherapy, followed by 2 additional cycles after surgery (arm B). RESULTS Fifty-two out of 84 patients (61.9%) experienced disease recurrence, and for 41 the site of disease was identified. Distant, peritoneal, and local relapses occurred in 21 (51.2%), 11 (26.8%), and 5 (12.2%) patients, respectively. The median follow-up was 79 months (range: 4.2-120 months). The 5-years RFS was 39.0% [95% confidence interval (CI): 27.9-49.9]. cT4 tumors had a higher risk of recurrence compared to those with cT2-3 tumors (hazard ratio = 1.92; 95%CI: 1.03-3.56; P = 0.038). The 5-years and 7-years OS was 58.7% (95%CI: 41.9-72.2) and 47.3% (95%CI: 29.4-63.2) in arm A and it was 55.0% (95%CI: 38.4-68.9; P = 0.806) and 46.8% (95%CI: 30.7-61.5; P = 0.806) in arm B, respectively. CONCLUSION Distant metastases are the most common relapse sites, within two years after surgery; RFS depends on tumor size, histology and treatment response; median OS was 69.6 months with favorable long-term outcomes.

Abstract Dehydration is a frequent complication among rectal cancer patients after ileostomy, often resulting in hospital readmission. The Dehydration Readmission after Ileostomy Prediction (DRIP) score was used to identify patients at risk of dehydration-related readmission. The aim of this study is to assess the predictive value of the DRIP score for dehydration–electrolyte imbalance (DIE) and hospital readmission in a multicenter Italian cohort. A total of 306 patients with rectal adenocarcinoma who underwent anterior resection with protective ileostomy in 2022 were included. The main outcome measures were the incidence of early and late DIE, hospital readmission due to DIE, and correlations between the DRIP score and other clinical variables. Early DIE occurred in 16.3% of the patients, with 2.6% requiring readmission. Late DIE occurred in 13.7% of the patients, with 3.6% requiring readmission. The DRIP score was significantly correlated with early DIE. A high DRIP score was associated with an increased risk of early and late DIE. Independent predictors of early DIE included high BMI and early postoperative complications. Parastomal infection was the only independent predictor of late readmission. The DRIP score represents a useful tool for identifying patients at risk of early dehydration following ileostomy. While its ability to predict hospital readmission is limited, it provides clinically relevant risk stratification for early DIE and may support targeted postoperative monitoring strategies. Future studies should integrate dynamic patient-specific data to increase the predictive accuracy of the score and guide both inpatient and outpatient care.

Background: Indocyanine green (ICG)-guided surgery is an emerging technique to enhance intraoperative visualization of nodes and tumor location. However, there is no uniform protocol regarding the optimal timing, dosage, or injection site for ICG in colorectal cancer surgery. We assess the feasibility of ICG injection at the anorectal junction immediately before surgery to safely identify the inferior mesenteric artery (IMA). Methods: This was a prospective study involving robotic left hemicolectomy or anterior resection of the rectum for primary colorectal cancer in 2024 in a single center. A total of 10–20 mg was injected into the anorectal submucosa at four quadrants circumferentially using an anoscope immediately before robot docking. Results: In this first study, ICG allowed us to identify the IMA in 84.6% of 26 patients (mean age 66.5 years; BMI 26.7 kg/m2), without intraoperative medical and surgical complications. Elevated BMI correlated with failure of IMA detection (r = −0.77, p < 0.001), despite high ICG doses trending toward improved vascular visualization (p = 0.097). A mean of 22 lymph nodes was harvested after ICG injection, with yields unaffected by the quality of IMA visualization. Conclusions: Submucosal injection of ICG is a feasible and easily adoptable option for early identification of the IMA, thereby preventing major vascular injuries, particularly in patients with challenging anatomy. A standardized protocol was implemented to improve reliability.

INTRODUCTION:Evidence regarding staging laparoscopy (SL) for clinical metastatic (cM+) gastric cancer (GC) patients is limited. Recently, an Italian Gastric Cancer Research Group (GIRCG) study showed SL changed peritoneal status in over 20% of cases. This study aimed to evaluate SL's role in cM+ patients and refine its indications. METHODS:Clinical data of cM+ GC patients who underwent SL between 2010 and 2022 at nine GIRCG centers were retrospectively analyzed. The primary outcome was SL's yield, defined as peritoneal status changed by SL over all SLs. RESULTS:Among 182 cM+ patients who received SL, 38 (20.9%) had SL-findings changing peritoneal status. Notably, 10.1% of cases with preoperative signs of carcinomatosis had no peritoneal disease, while 46.3% with extraperitoneal disease alone had peritoneal carcinomatosis (PC) at SL. Thirty-one patients (17.0%) underwent R0 resection: 17 (54.8%) with PC, 3 (9.7%) with liver metastases, 4 (12.9%) with PC and nodal metastases, 2 (6.4%) with lung, and 1 (3.2%) with bone metastases. Seventeen patients with suspected preoperative PC underwent curative treatment: 9 had peritoneal disease ruled out by SL, while the other 8 had limited PC, allowing R0 resection. Logistic regression revealed an inverse correlation between diffuse histotype and absence of PC at SL in patients with peritoneal involvement at imaging (p = 0.02). CONCLUSION:SL aids in directing cM+ GC patients to appropriate treatment, with a 20.9% yield. For those with peritoneal involvement at imaging, SL helps identify candidates for curative treatment. In patients with extraperitoneal disease, SL should be considered to assess potential radical strategies.

Ulcerative colitis (UC) is associated with an increased risk of developing colitis-associated colorectal cancer (caCRC), a major complication of long-standing disease. In this review, we examined the pathogenic association between UC and caCRC, highlighting the risk factors, molecular mechanisms, and current strategies for prevention and management. Compared to sporadic colorectal cancer, caCRC tends to occur at a younger age and is more frequently characterized by mucinous or signet-ring cell histology, proximal colonic involvement, and a higher incidence of synchronous lesions. The risk of caCRC increases 8-10 years after UC diagnosis and is influenced by disease duration, extent of colonic involvement, inflammatory burden, family history of colorectal cancer, and coexisting primary sclerosing cholangitis. The inflammation-to-cancer progression follows a multistep pathway of genetic alterations, advancing from low-grade to high-grade dysplasia, and ultimately to carcinoma. While chemopreventive agents such as 5-aminosalicylates may offer some benefit, surveillance colonoscopy remains the primary strategy for risk reduction. Early detection and individualized prevention strategies are critical for improving long-term outcomes in patients with UC.

OBJECTIVES:The prognostic significance of microsatellite instability (MSI) and HER2 status in advanced gastric cancer (AGC) treated with neoadjuvant or conversion chemotherapy (NAC) remains unclear. This study aimed to evaluate their impact on pathological response and survival outcomes in AGC patients undergoing NAC followed by surgery. METHODS:This single-center, retrospective observational study included 121 patients with gastric adenocarcinoma at clinical stage >cT2N0, defined as tumor invasion beyond the muscularis propria, nodal involvement, or both. Eligible patients received at least two cycles of NAC and underwent surgical resection. Adults without other malignancies and with biopsy samples available for molecular analysis were included. Data were obtained from a prospectively maintained surgical database. Imaging studies were reviewed by expert radiologists, and molecular analyses were performed in the pathology department. RESULTS:Among the 121 patients, MSI was identified in 6.6% and HER2 positivity in 9.9%. All MSI tumors were HER2 negative ( P  < 0.001). HER2 positivity was more frequent in intestinal-type tumors ( P  = 0.034) and was associated with better pathological response ( P  = 0.048). The 5-year overall survival (OS) rate was 44.7%, with a median OS of 42.6 months. Multivariate Cox regression identified tumor location in the upper third, residual tumor, nodal stage, Lauren diffuse-mixed histotype, and negative HER2 status as independent prognostic factors ( P  < 0.05). MSI status was not significantly associated with OS ( P  = 0.786), although a trend toward improved survival was observed in MSI-H patients. CONCLUSIONS:HER2 overexpression correlated with better pathological response and independently predicted improved OS. MSI and HER2 status may serve as biomarkers to guide preoperative treatment strategies in AGC.

Background: PIPAC is an innovative treatment that delivers low-dose aerosolized chemotherapy into the abdominal cavity of patients with peritoneal surface malignancies (PSMs). However, its role in the multimodal management of PSMs is unclear. Methods: We retrospectively analyzed data from 64 patients who underwent PIPAC for PSMs of a primary or secondary origin between June 2020 and December 2024 (median age of 64 years). Primary tumor sites included gastric (42.2%), colorectal (23.4%), ovarian cancer (21.9%), and others (12.5%). The median PCI was 15 (IQR 9-25), with ascites present in 60.9% of cases and a positive cytology in 48.4%. Results: A total of 82 PIPAC sessions were performed in 64 patients. The mean operation time was 96 min. Severe adverse events, defined as the Common Terminology Criteria for Adverse Events (CTCAE) of a grade ≥ 2, occurred in four patients (6.2%). The median hospital stay was 3 days, and systemic chemotherapy was resumed within 14 days after the procedure in 27 patients. Among the entire cohort, 37.5% received bidirectional therapy and 62.5% received palliative treatment, with a lower peritoneal cancer index (PCI) in the bidirectional group (9.5 vs. 23). The median overall survival (OS) was 32 months from diagnosis. Sixteen patients (25%) underwent two or more PIPAC sessions and showed an advantage in survival compared to patients who underwent only one procedure (3-year OS: 63.2% vs. 38.4%, p 0.030). Conversion surgery was achieved in 34.4%. Patients treated with a bidirectional intent demonstrated a longer OS (3-year: 66.0% vs. 33.9%, p 0.011). Colorectal and ovarian tumors exhibited better long-term outcomes compared to gastric cancer. Conclusions: PIPAC is a promising treatment for PSMs, with a low morbidity rate. Its favorable safety and short interval to systemic therapy resumption support its use as part of a bidirectional strategy.

Background and Objectives: Hepatolithiasis (HL), or intrahepatic bile duct stone disease, shows regional variation and is a rare condition in Western countries. While cases from East Asia are often linked to chronic biliary infections and brown pigment stones, Western HL more frequently involves cholesterol or black pigment stones, typically in the context of prior cholecystectomy, biliary interventions, or congenital anomalies. The disease is generally associated with significant morbidity, including recurrent cholangitis, biliary strictures, and risk of cholangiocarcinoma. This study aimed to characterize HL disease in an Italian case series. Materials and Methods: We retrospectively reviewed 1450 patients with biliary stone disease treated between 2010 and 2024. HL was diagnosed in 14 patients (0.96%). Clinical records, imaging (ultrasound, CT, magnetic resonance cholangiopancreatography—MRCP, cholangiography), bile cultures, and stone composition (categorized as cholesterol, brown pigment, black pigment, or mixed using FTIR/XRD) were analyzed. Results: Among the 14 patients (mean age: 60.1 years; 64.3% female), 71.4% presented with recurrent cholangitis, while 28.6% were asymptomatic. Stones were left-sided in 57.1%, right-sided in 21.4%, and bilateral in 21.4%. Stone composition was cholesterol/mixed in 50%, brown pigment in 35.7%, and black pigment in 14.3%. Risk factors for bile stasis were present in 71.4% of cases. Bile cultures (available in nine cases) were positive in 77.8%. MRCP was highly effective for diagnosis. Hepatectomy achieved complete resolution in 35.7% of patients with unilobar disease; endoscopic/percutaneous therapy had a 44.4% recurrence rate. Interestingly, no cholangiocarcinoma was observed over a median follow-up of 4.8 years. Conclusions: Western HL is a rare, heterogeneous disease with distinct features. Cholesterol-predominant, infection-negative cases suggest a metabolic or surgical etiology. Hepatectomy offers durable outcomes in unilobar disease. Advanced imaging (MRCP, cholangioscopy) and personalized strategies are key to effective management.

Background: Surgical resection remains central to the curative treatment of locally advanced gastric cancer (GC), yet global variability persists in defining resectability, particularly in complex scenarios such as multivisceral invasion, positive peritoneal cytology (CY1), or oligometastatic disease. The Intercontinental Criteria of Resectability for Gastric Cancer (ICRGC) project was developed to address this gap by combining expert surgical input with artificial intelligence (AI)-based reasoning. Methods: A two-stage prospective survey was conducted during the 2024 European Gastric Cancer Association (EGCA) meeting. Fifty-eight surgical oncologists completed a 36-item questionnaire on resectability, strategy, and quality metrics. Subsequently, they reviewed AI-generated responses based on current clinical guidelines and completed a second round. Concordance between human and AI responses was classified as full, partial, or discordant, and changes in surgeon opinions were statistically analyzed. Results: Substantial agreement was observed in evidence-based domains. Seventy-nine percent of surgeons agreed with AI on distinguishing technical from oncological resectability. In cT4b cases, 61% supported restricting multivisceral resection to high-volume centers. Similar alignment was found in CY1 (54%) and N3 nodal disease (63%). Partial concordance appeared in areas requiring individualized judgment, such as peritonectomy or bulky-N disease. After AI exposure, surgeon responses shifted toward guideline-consistent decisions, including increased support for cytoreductive surgery only when CC0/1 was achievable and stricter classification of R2 resections as unresectable. Following AI exposure, 27.1% of surgeons changed at least one answer in alignment with AI recommendations, with statistically significant shifts observed in items related to surgical margin definition (p = 0.015), anatomical resection criteria (p < 0.05), and hospital stay benchmarks (p = 0.031). Conclusions: The ICRGC study demonstrates that AI-driven consensus modeling can replicate expert reasoning in complex surgical oncology and serve as a catalyst for harmonizing global practice. These findings suggest that AI-supported consensus modeling may complement expert surgical reasoning and promote greater consistency in decision-making, particularly in controversial or ambiguous cases.

Epithelial-to-mesenchymal transition (EMT) is a biological process by which epithelial cells increase their motility and acquire invasive capacity. It represents a crucial driver of cancer metastasis and peritoneal dissemination. EMT plasticity, with cells exhibiting hybrid epithelial/mesenchymal states, and its reverse process, mesenchymal-to-epithelial transition (MET), allows them to adapt to different microenvironments and evade therapeutic intervention. Resistance to conventional treatments, including chemotherapy, is a major problem. Therapies targeting EMT may inhibit tumour cell migration and invasion, while affecting normal cells and repair mechanisms, resulting in potential side effects. This paper addresses the question of the impact of EMT status on cancers with potential spread to the peritoneum, which has remained unclear in literature. Relevant studies were selected from 2000 to 2024. Three macrosections were analysed: (i) pathological characteristics, (ii) surgical implications and (iii) oncological therapies. The focus was on survival and peritoneal recurrence time in patients who underwent surgical treatment.

Background: Anal HPV infection can cause squamous intraepithelial lesions (SILs), which are precursors of anal squamous cell carcinoma (SCC). The early detection of HPV infections and improvement of effective screening programmes are, therefore, essential to prevent progression from pre-cancerous lesions to SCC, especially in people living with HIV (PLWH), who represent a population at higher risk of HPV infection and associated lesions. Among prevention strategies, HPV vaccination is relevant too, but its efficacy in persons already infected by HPV is still debated. Methods: This is a retrospective single-center study on a cohort of PLWH who performed longitudinal screening for anal dysplasia and HPV infection. The screening included cytological and molecular analyses. Results: A total of 110 PLWH performed at least one anal HPV screening, with an overall prevalence of HPV infection of 86.4% [23.6% low risk (LR)-HPV and 62.7% high risk (HR)-HPV genotypes]. Abnormal cytology was demonstrated in 39.1% of subjects, of whom ASCUS 6.4%, LSIL 30.9% and HSIL 1.8%. In total, 80 patients (72.7%) had an available longitudinal screening. No patient developed SCC during follow-up. However, a high incidence of new cytological abnormalities and new HPV infections was observed. On the other side, clearance of some HPV genotypes was also frequent, confirming that HPV infection is a dynamic process. A CD4 cell count > 500/mmc was an independent predictor of HPV clearance. HPV vaccination was performed on 30.9% of patients. A trend toward an increased clearance of HPV genotypes included in 9-valent vaccine was observed in vaccinated patients (40.6% versus 30.8% in unvaccinated, p = 0.079). Conclusions: A high prevalence of HPV infection and SILs was observed in our cohort of PLWH. A high incidence of new HPV infections and HPV-associated lesions was also observed in the longitudinal cohort, highlighting the need of strengthening immunization programs and continuous screening for anal HPV infection. Whether HPV vaccination may be efficacious in patients already infected by HPV remains to be determined.

Introduction: In this first preclinical evaluation study of the hinotori™ system in gastric resection procedure, its capabilities to perform distal and total gastrectomy while using human cadaver models were evaluated. METHODS:Three robotic distal gastrectomies (RADGs) and one total gastrectomy were performed in human cadavers using the same setup. A delta-shaped anastomosis in the RADG procedures were performed with a manual stapler. RESULTS:The mean operative time for three distal gastrectomies was 118 min, while the total gastrectomy procedure focused on the resection only. The dissection could be made up to pulmonary veins, while the entire setup was kept. The procedures were done safely according to the surgical standards with smooth instrument and overall performance without any complications seen. An ergonomic surgeon cockpit and head rest supported the outcome. CONCLUSION:Docking-free design and human arm-like movement with a high degree of operation arm mobility showed a wide range of motion of the wristed robotic instruments. This could be beneficial for multiquadrant procedures resulting in potential shorter procedures times with smother performance, which should be evaluated in further studies. .

BACKGROUND:The recent introduction of multimodal approach in the setting of conversion surgery (CS) significantly improved survival of stage IV gastric cancer (GC) patients. The prognosis has been related to several tumor and patient factors. Abnormal body composition, specifically the depletion of the lean mass compound, have been associated with impaired short- and long-term outcomes in GC. Aim was to analyze potential variation of body composition during systemic treatment and to evaluate aftermath on further resection and survival. METHODS:In this retrospective monocenter analysis, we assessed pre-treatment and preoperative body composition of stage IV GC patients who underwent surgical exploration following systemic treatment in the setting of CS, over a 12-year period. A radiologist blinded to the patient outcomes assessed the areas of skeletal muscle, and adipose tissue by a dedicated software through standardized protocols. Demographics and clinical data were obtained from prospectively maintained databases and patient records. RESULTS:We included 42 GC patients. Median age was 59 years, 27, 64.3 % were male, and 22/42 were Yoshida category 3 and 4. Surgical interventions included curative resection (23/42 cases), or palliation (19/42). We observed difference in the distribution of body components according to gender, at diagnosis, with more subcutaneous adipose tissue in males (p < 0.001) vs. more visceral adipose tissue in females (p = 0.039). During systemic treatment, a significant increase in total muscle area was observed, but nor in males (median delta TMA -7cm2 in males and delta TMA +4.8 cm2 in females, p = 0.048). Increased TMA during chemotherapy was associated with improved overall survival, with median OS 63 months, vs. 27 months for patients who lost lean mass (p = 0.042). The protective effect of increased TMA was also confirmed at a multivariate analysis after normalization for age and type of surgical procedure (HR 0.98, 95%CI 0.97-0.99; p = 0.035). CONCLUSION:As increased skeletal muscular mass during systemic treatment independently improved the overall survival, longitudinal evaluation of body composition must be part of routinary work-up of gastric cancer patients in the setting of conversion surgery. Potential effects of nutritional interventions must be evaluated.

Gastrectomy is the cornerstone of treatment for gastric cancer. Since the introduction of minimally invasive techniques, the main challenge for surgeons has been to achieve the same surgical radicality, adequate lymphadenectomy, and negative resection margins as with the open approach. Previous Eastern trials showed non-inferiority of laparoscopic gastrectomy, whereas Western trials reported a higher number of complications. This may depend on the different eligibility criteria to select patients and surgeons. Currently, the increased availability of robotic systems has led to renewed enthusiasm. We present a critical review of published randomized control trials (up to October 2024) to investigate the real benefits of robotic compared to open and laparoscopic approaches. Robotic gastrectomy has shown similar oncological outcomes in survival and lymph node retrieval, particularly in suprapancreatic stations, with the advantage of a more acceptable rate of pancreatic fistula and feasible anastomotic reconstruction. Some clinical situations, such as postchemotherapy interstitial fibrosis and distortion of anatomical planes, may increase the technical difficulty. Only four published trials assessed the implications of a pre-operative therapy, with no robotic surgery cases. Robotic systems may reduce intraoperative blood loss, the risk of conversion and allow more extensive lymphadenectomies in cancers with a high risk of extraperigastric metastases, or with clinically proven para-aortic node metastases, although clinical trials evaluating robotic gastrectomy after neoadjuvant therapy have not yet been published.

Cystic mucinous neoplasms (MCNs) of the pancreas are rare cystic tumors, accounting for approximately 2-5% of all pancreatic neoplasms. They predominantly occur in premenopausal women and are typically located in the body or tail of the pancreas. Due to their potential for malignant transformation, especially in cases associated with invasive carcinoma such as pancreatic ductal adenocarcinoma, early detection, complete surgical resection, and rigorous postoperative surveillance are essential. The occurrence of MCNs in male patients is exceedingly rare, comprising only about 2% of reported cases, and often resulting in preoperative diagnostic challenges. Molecular analyses have identified a strong association between KRAS mutations and disease progression in MCNs, underscoring their potential role as prognostic markers despite limited diagnostic utility. In this report, we present two additional cases of MCNs in male patients, highlighting their histopathological features and the ancillary investigations undertaken to support diagnosis.